The Complexities of Listening and Understanding in Children with Minimal / Mild Hearing Loss  Dawna Lewis (USA)

1. The Complexities of Listening and
Understanding in Children with
Minimal / Mild Hearing Loss
Dawna Lewis
Phonak Sound Foundations 2013
Chicago, IL

2. Definitions of MMHL
• Heterogeneous group of hearing loss configurations
• All losses may be conductive or sensorineural
• Represent over 5% of school-age children (Bess et al, 1998;
Niskar et al, 1998)
Bilateral Unilateral High Frequency
Minimal: 16-25 dB HL
Mild: 25-45 dB HL
Affected ear > 20 dB HL >25 dB HL for 2 or more
frequencies above 2 kHz

3. What are the effects of minimal/mild
hearing loss on children?
• The answers are not always as clear as we’d
like them to be
• What does research tell us?

4. Potential Difficulties
Communication
• Soft/distant
speech
• Noise/
reverberation
• Localization
• Listening effort
• Speech/language
Academic/
Cognitive
• Grade retention
• Additional
educational
assistance
• Verbal academic
tests
• Full-scale IQ
Psychosocial
• Teacher ratings
• Perceived
functional health
• Physical, social,
emotional
functioning
• Attention
(Bess et al., 1986; Bess et al., 1998; Bess & Tharpe, 1986; Borton et al., 2010; Crandell, 1993;
Culbertson & Gilbert, 1986; English & Church, 1999; Johnson et al., 1997; Klee & Davis-Dansky,
1986; Lieu et al., 2010, 2012; Porter et al. 2013; Ruscetta et al., 2005; Newton, 1983; Oyler et al.,
1987, 1988)
4

5. Similarities
Communication
• Standardized
Language
measures
• Speech
perception in
quiet
• Speech
perception in
noise
Academic/
Cognitive
• IQ
• Verbal
• Non-verbal
• Full scale
• Reading
• Academic Skills
Psychosocial
• Behavior
• Teacher ratings
of performance
• Self-concept
• Quality of life
Bess et al., 1998; Borton et al., 2010; Crandell, 1993; Culbertson & Gilbert, 1986; Klee & Davis-
Dansky, 1986; Lewis et al., submitted; Lieu et al., 2010, 2012; Porter et al., 2013)
5

6. Why can’t we all agree?
• Heterogeneity of hearing losses within the
same population
• Perceptions
• Tests

7. Heterogeneity of Hearing Losses

8. Perceptions
• Person with MMHL may not realize what is
being missed
• Perceptions of difficulties may influence
expectations, behaviors, and progress
If a tree falls…….?

9. Effects of Minimal/Mild Hearing Loss:
Children’s, Parents’, Teachers’ Perceptions
Subjects
• 20 children (8-12 years) with unilateral or bilateral
MMHL
• One parent/guardian of each child
• One classroom teacher for 10 of the children
Procedures
• Structured interviews were conducted
• Broad topic areas
Analysis
• Qualitative and quantitative methods

10. Challenge versus No-Challenge
28.8%
31.5%
15.2%
33.2%
27.0%
9.2%
28.6%
26.2%
6.8%
11.9% 7.3%
5.4%
14.9%
8.2%
7.6%
17.4%
15.7%
5.3%
0%
10%
20%
30%
40%
50%
60%
%ofAllCodedUtterances
Awareness / Groups/ Limited Visual
Understanding Noise Access
Child: No Challenge
Child: Challenge
Parent: No Challenge
Parent: Challenge
Teacher: No Challenge
Teacher: Challenge

11. Challenges Reported as Not Related to Hearing
Loss (Triads only)
0
5
10
15
20
25
30
35
40
Personality Control Negative
Behavior
Academic
Challenges
Attention Same as
Normal
Hearing
NumberofOccurrences
Parent
Teacher
11

12. What do these preliminary results
suggest?
• Perspectives are important
– Clinician/family/educator understanding
– Counseling
– Habilitation
– Critical review of the literature

13. Tests
• Who/what/where/when are you testing?
• Sensitivity to potential problems

14. Comprehension and sentence recognition by Children
with MMHL in a simulated classroom environment
(Lewis et al., submitted)
• Previous work in our lab
– children adults with NH (Valente et al., 2012)
• Participants
– 18 children (8-12 yrs) with NH and 18 with MMHL
• 8 with bilateral HL
• 10 with unilateral HL
– Age-matched
– WASI 2FSIQ within 1.25 SD of mean
– All testing completed without amplification

15. •Testing took place in a
simulated classroom with
control of acoustics,
noise and listening tasks
•Realistic classroom
learning task:
•video recordings of
talkers positioned around
the subject,
•Teacher + 4 Students
•Speech recognition task:
•Sentence repetition
•Single talker, auditory-
only
•Quasi-randomly from
the 5 loudspeakers
•Acoustical environment
•Neutral spectrum
background noise, HVAC
systems at 50 dBA
•Talkers presented at 60
dBA
•+10 dB SNR at
listening location
•600 ms RT60 at 1 kHz

16. Looking Behavior
• Proportion of Events Visualized
– How often listeners looked directly at the talker as
he/she was speaking during the classroom
learning task
• Overall looking behavior

17. Results
•Sentence Recognition
•All except 2 children with
MMHL scored > 89%
•Comprehension
•Significant effect of age
and HL (p<.05)
•No age x HL interaction

18. Looking Behavior
• How often did
listeners look
directly at the talker
as he/she was
speaking?
• No significant
differences across
age or HL and no
interactions

19. • Looking behavior
•No significant differences
across age or HL and no
interactions
•MMHL children show a
different pattern of looking
behavior than the NH
children

21. What do these results tell us?
• Despite performing at or near ceiling on a
sentence recognition task, younger children
with NH and children with MMHL perform
more poorly than older children with NH on
more complex listening tasks
• Individual looking behaviors vary
– Under some conditions, it is possible that
attempting to visualize the talker may inefficiently
utilize cognitive resources that would otherwise
be allocated for comprehension

22. Summary
• Multiple factors can influence how we
understand the potential difficulties that may be
experienced by children with MMHL
• Tasks representing the types of listening and
learning activities experienced in classrooms
under plausible acoustic conditions may be better
indicators of real-world speech understanding in
these environments than simple speech
recognition tasks

23. Thanks for listening!